Prognostic value of ECOG performance status and Gleason score in the survival of castration-resistant prostate cancer

Abstract

Eastern Cooperative Oncology Group (ECOG) performance status and Gleason score are commonly investigated factors for overall survival (OS) in men with castration-resistant prostate cancer (CRPC). However, there is a lack of consistency regarding their prognostic or predictive value for OS. Therefore, we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories. A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019. The data from 8247 patients in 34 studies, including clinical trials and real-world data, were included in our meta-analysis. Of these, twenty studies reported multivariate results and were included in our main analysis. CRPC patients with higher ECOG performance statuses (≥ 2) had a significantly increased mortality risk than those with lower ECOG performance statuses (<2), hazard ratio (HR): 2.10, 95% confidence interval (CI): 1.68–2.62, and P < 0.001. The synthesized HR of OS stratified by Gleason score was 1.01, with a 95% CI of 0.62–1.67 (Gleason score ≥ 8 vs <8). Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy (docetaxel and cabazitaxel) and androgen-targeting therapy (abiraterone acetate and enzalutamide) or for patients with different chemotherapy histories. ECOG performance status was identified as a significant prognostic factor in CRPC patients, while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.

Assessment of androgen receptor signaling inhibitors therapy in metastatic hormone-sensitive prostate cancer

“…Because of the concomitant use with prednisolone, the mineralocorticoid effect might have caused adverse events in the abiraterone group 24 . Even though serious adverse events, e.g., seizure and febrile neutropenia from enzalutamide or tachycardia and transaminitis form abiraterone were reported, none of those were presented in this study 6,24,27 . All adverse events were grades 1 to 2 and did not lead to treatment withdrawal.…”

“…The related study demonstrated the potential predictive value of ECOG (ECOG ≥2 vs <2) for OS among patients with metastatic prostate cancer 27 . A significant difference between ECOG score of 0 and 1 to 2 on OS and PFS was not found 28 .…”

Commentary: The impact of palliative transurethral resection of the prostate on the prognosis of patients with bladder outlet obstruction and metastatic prostate cancer: A population-matched study

“…The main reason was imbalance in disease severity between the two groups, particularly in terms of performance status and self-care ability (e.g., ECOG score), which would have led to a substantial selection bias in the prognostic analysis. ECOG score was considered to be a significant prognostic factor in castration-resistant prostate cancer ( 5 ).…”

Useful predictors of progression‐free survival for Japanese patients with LATITUDE‐high‐risk metastatic castration‐sensitive prostate cancer who received upfront abiraterone acetate

“…Regarding the Gleason pattern 5, prostate cancer with a Gleason score 9–10 is indicative of particularly aggressive disease 20–22 . PS as a prognostic factor for OS has been evaluated in men with CRPC 23 . Furthermore, several recent investigators have advocated that anemia is a powerful prognostic factor in PC 24,25 .…”

“… 20 , 21 , 22 PS as a prognostic factor for OS has been evaluated in men with CRPC. 23 Furthermore, several recent investigators have advocated that anemia is a powerful prognostic factor in PC. 24 , 25 In particular, Okamoto et al .…”